Topic: health care

The new, April, issue of National Geographic has maps of life expectancy for each county in the United States for 1989 and for 2009. (Apparently the digital version allows you to click on any particular county and get the local information, once you shell out $19.95 for a digital subscription.)

The story emphasizes the fact that life expectancy for men has increased more than it has for women over these 20 years and suggests that this may be due to inadequate treatment for women with high blood pressure and cholesterol. But it seems to me (though I am no epidemiologist) that that discrepancy might be due to the fact that women live longer than men and thus have less upside potential.

The new, April, issue of National Geographic has maps of life expectancy for each county in the United States for 1989 and for 2009. (Apparently the digital version allows you to click on any particular county and get the local information, once you shell out $19.95 for a digital subscription.)

The story emphasizes the fact that life expectancy for men has increased more than it has for women over these 20 years and suggests that this may be due to inadequate treatment for women with high blood pressure and cholesterol. But it seems to me (though I am no epidemiologist) that that discrepancy might be due to the fact that women live longer than men and thus have less upside potential.

To me, the most startling fact in this data dump is just how fast life expectancy has increased for both sexes: 4.6 years for men and 2.7 years for women. That’s a 6.4 percent increase for men and a 3.4 percent increase for women in just two decades.

There was a similar leap in life expectancy in the early 20th century, but that increase was due to much lower infant and childhood mortality thanks to vaccines against such child-killers as whooping cough and diphtheria and the mandated pasteurization of milk, which eliminated the horrendous number of infant deaths caused by impure milk.

This latter-day increase comes at the end of life. Partly it is due to medicine’s greatly increased ability to cure or manage such killers as pneumonia, heart disease, and cancer. Partly it is due to a greatly improved environment, especially in cities and factories. And partly it is due to improved life styles, with more exercise and less fat, alcohol and tobacco.

There is no reason to think that this increase in life expectancy will abate any time soon. Indeed, it may accelerate. And that has tremendous public-policy implications with regard to Social Security, Medicare, etc. And as the percentage of old people increases in the population, their political clout will increase with it.

Some conservatives have complained that the House vote to repeal ObamaCare tomorrow is just for show and has no chance of passing the Senate or — even if it miraculously did — surviving a presidential veto. True, but so what? Many voters are just starting to tune in to the general election, and it’s worth getting the latest positions of House lawmakers on the record. For Democrats running in conservative districts, this could be the last shot to oppose the unpopular health care law before the election. For Republicans, it’s a chance to show they’re on the side of the majority of Americans who oppose ObamaCare.

And for the White House, it’s a potential political embarrassment, depending on how many Democrats switch over to the anti-ObamaCare side. The Hillreports:

Only three Democrats voted for repeal after the GOP took control of the House last year, but Republicans are confident they can add to this number on Wednesday in spite of the Supreme Court’s ruling that the law is constitutional.

Already, one politically vulnerable Democrat, Rep. Larry Kissell (N.C.), has said he will vote to repeal the health care law after opposing the same measure a year ago.

The GOP’s hope is that a strong House vote — and fresh Democratic opposition — will thwart the White House’s effort to boost political support for the law in light of the Court ruling, said one House Republican leadership aide. Conservatives complaining about symbolic votes are being unrealistic.

Some conservatives have complained that the House vote to repeal ObamaCare tomorrow is just for show and has no chance of passing the Senate or — even if it miraculously did — surviving a presidential veto. True, but so what? Many voters are just starting to tune in to the general election, and it’s worth getting the latest positions of House lawmakers on the record. For Democrats running in conservative districts, this could be the last shot to oppose the unpopular health care law before the election. For Republicans, it’s a chance to show they’re on the side of the majority of Americans who oppose ObamaCare.

And for the White House, it’s a potential political embarrassment, depending on how many Democrats switch over to the anti-ObamaCare side. The Hillreports:

Only three Democrats voted for repeal after the GOP took control of the House last year, but Republicans are confident they can add to this number on Wednesday in spite of the Supreme Court’s ruling that the law is constitutional.

Already, one politically vulnerable Democrat, Rep. Larry Kissell (N.C.), has said he will vote to repeal the health care law after opposing the same measure a year ago.

The GOP’s hope is that a strong House vote — and fresh Democratic opposition — will thwart the White House’s effort to boost political support for the law in light of the Court ruling, said one House Republican leadership aide. Conservatives complaining about symbolic votes are being unrealistic.

ObamaCare isn’t going away unless President Obama is voted out of office, which means all the GOP can do at the moment is apply political pressure to Democrats and sympathize with voter anger about the law. Because House Democratic leaders are trying to change the subject away from health care, that means it’s probably working:

Democrats, meanwhile, are seeking to portray the GOP as myopically focused on health care at the expense of the economy and other problems. The office of Minority Leader Nancy Pelosi (D-Calif.) released a video mocking the vote by using the mantra employed by Speaker John Boehner (R-Ohio): “Where are the jobs?”

To refresh Pelosi’s memory, it wasn’t the Republicans who jammed through Obama’s health care law instead of focusing on job creation. Now that ObamaCare’s been spared by the Supreme Court, Democrats would prefer to ignore the unpopular law until after November. House votes like the one tomorrow won’t let them.

There is something about conservatives using the word “freedom” that drives the left insane. Maybe because progressives like to see themselves as champions of the people, fighting against the system, rather than what they actually are: statists, attempting to impose their beliefs on individuals through government power.

At the Huffington Post, AFL-CIO boss Richard Trumka reimagines the concept of “freedom” today in a column that is just as Orwellian as you would think (h/t Washington Examiner):

I do believe that freedom isn’t free — but today the corporate and political right wing is trying to cheapen this truly American value. They’ve been cynically using the word “freedom” to rally the American public against its own best interests.

She’s referring, I guess, to the freedom to go without health care when you’re sick.

In its otherwise positive decision, the Supreme Court gave states the “freedom” to deny Medicaid coverage to their poorest residents — even though the federal government would pick up the tab.

Wisconsin Gov. Scott Walker received the National Rifle Association’s “Defender of Freedom” award recently. I guess they meant Gov. Walker is defending teachers’ freedom from joining with coworkers to bargain fairly about things like class size. …

Let’s call this right-wing “freedom” catch phrase what it really is: a grossly political strategy to dupe the public, which holds the word “freedom” as something sacred.

This Independence Day, I say let’s go back to a truer use of the word “freedom.” Let’s start with President Franklin Roosevelt’s Four Freedoms: freedom of speech and expression, freedom of worship, freedom from want and freedom from fear. I would add the freedom to bargain collectively.

There is something about conservatives using the word “freedom” that drives the left insane. Maybe because progressives like to see themselves as champions of the people, fighting against the system, rather than what they actually are: statists, attempting to impose their beliefs on individuals through government power.

At the Huffington Post, AFL-CIO boss Richard Trumka reimagines the concept of “freedom” today in a column that is just as Orwellian as you would think (h/t Washington Examiner):

I do believe that freedom isn’t free — but today the corporate and political right wing is trying to cheapen this truly American value. They’ve been cynically using the word “freedom” to rally the American public against its own best interests.

She’s referring, I guess, to the freedom to go without health care when you’re sick.

In its otherwise positive decision, the Supreme Court gave states the “freedom” to deny Medicaid coverage to their poorest residents — even though the federal government would pick up the tab.

Wisconsin Gov. Scott Walker received the National Rifle Association’s “Defender of Freedom” award recently. I guess they meant Gov. Walker is defending teachers’ freedom from joining with coworkers to bargain fairly about things like class size. …

Let’s call this right-wing “freedom” catch phrase what it really is: a grossly political strategy to dupe the public, which holds the word “freedom” as something sacred.

This Independence Day, I say let’s go back to a truer use of the word “freedom.” Let’s start with President Franklin Roosevelt’s Four Freedoms: freedom of speech and expression, freedom of worship, freedom from want and freedom from fear. I would add the freedom to bargain collectively.

The “freedom to go without health care when we’re sick” isn’t the issue, unless Trumka is arguing that the state should force every sick person in the country to get medical attention. We all have the freedom to decide whether or not to see a doctor when we are sick, just like we should all have the freedom to decide not to pay for health care (insurance) when we are well. We have the freedom to move if we disagree with our state’s decision to not participate in Medicare expansion. And we also have the freedom to elect a new state governor who will participate in it, or lobby the current governor to do it, if that’s our preference.

We should all have the freedom to decide whether or not to pay monthly dues to a union, instead of having the money automatically pulled from our paychecks. Trumka opposes “teachers’ freedom from joining with coworkers to bargain” — in other words, he thinks teachers should be forced to join with coworkers to bargain. Shouldn’t someone who professes to care about teachers support their freedom to make their own choices regarding their paychecks and their workplaces?

Trumka seems to grasp that this statist mentality is unpopular with the public, and that labor’s messaging strategy in Wisconsin was a failure. That’s why he’s so adamant about trying to reframe his positions as “pro-freedom,” as illogical as it sounds. The conservative arguments are working, and the left has very little ammunition to fight back.

As Jonathan noted yesterday, the left doesn’t want to admit that the entitlement system built up since the New Deal is collapsing under unrelenting and ineluctable fiscal and demographic pressures. But there is another reason that the medical part of the system is in such a mess: the utter lack of market forces to bring down prices and inspire innovation and efficiency.

The New York Times has an article this morning on the wildly varying prices for standard medical procedures, such as an appendectomy:

Hospital charges are all over the map: according to the report published Monday in the Archives of Internal Medicine, fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital.

“We expected to see variations of two or three times the amount, but this is ridiculous,” said Dr. Renee Y. Hsia, the study’s lead author and an assistant professor of emergency medicine at the University of California, San Francisco. “There’s no rhyme or reason for how patients are charged or how hospitals come up with charges. There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product,” she said. Though she is an emergency room doctor herself, Dr. Hsia said, she has no idea what the hospital charges for various procedures. When patients ask her, she has to tell them she doesn’t know.

As Jonathan noted yesterday, the left doesn’t want to admit that the entitlement system built up since the New Deal is collapsing under unrelenting and ineluctable fiscal and demographic pressures. But there is another reason that the medical part of the system is in such a mess: the utter lack of market forces to bring down prices and inspire innovation and efficiency.

The New York Times has an article this morning on the wildly varying prices for standard medical procedures, such as an appendectomy:

Hospital charges are all over the map: according to the report published Monday in the Archives of Internal Medicine, fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital.

“We expected to see variations of two or three times the amount, but this is ridiculous,” said Dr. Renee Y. Hsia, the study’s lead author and an assistant professor of emergency medicine at the University of California, San Francisco. “There’s no rhyme or reason for how patients are charged or how hospitals come up with charges. There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product,” she said. Though she is an emergency room doctor herself, Dr. Hsia said, she has no idea what the hospital charges for various procedures. When patients ask her, she has to tell them she doesn’t know.

The reason this is possible, of course, is that hardly anyone pays directly for medical care, especially emergency care. You go to the doctor or emergency room and do what you’re told and someone—insurance, the government, etc.—pays the bill. Because they don’t care what the answer is, no one ever asks the magic question: “How much is this going to cost?”

To be sure, someone arriving at the hospital with the acute abdominal pain of appendicitis is in a poor position to bargain, even if he has to care what the treatment is going to cost. But there are ways to bring price rationality to medicine even if the highly competitive pressures that force, say, all laptop computers to hover around the same price points, can never be fully in operation. There is a website, healthcarebluebook.com, that bills itself as “Your free guide to fair health care pricing.” It lists the “fair price” for various medical procedures by zip code. For the 85 percent of medicine that is non-emergency, this allows “customers” to get a sense of what the market would be if there were one.

It would be easy to get people to always ask the magic question for routine health care. It’s called the medical savings account, where people draw against a sum of money in an account to cover routine doctor visits and such. What they don’t spend in a year goes, tax-free, into their retirement account. “Do I really need this test, doctor?” would suddenly be heard in every medical office. The left has always fiercely resisted this idea, precisely because it would bring market forces to bear and bring down costs, reducing pressure to develop a single-payer system.

For the big-ticket items, such as an appendectomy, requiring doctors and hospitals to publish a schedule of prices for routine procedures without complications (which occur far more rarely in real life than they do in medical shows on television) would be a big step in the right direction. Suddenly they would have to justify their prices as reporters would ask why hospital X is charging three times as much as hospital Y, three miles away, for the same procedure. Those prices would begin to converge, and towards the lower end of the range. That, in turn, would force hospitals and other medical providers to search for ways to cut costs through increased efficiency and innovation.

There are trillions of dollars in excess costs in the medical system today that could be squeezed out by the simple application of market forces through the frequent use of the magic question. Democrats don’t want that question asked. Republicans should insist on it.

Before the Supreme Court’s oral argument on the Patient Protection and Affordable Care Act, I was told by people I trust that Paul Clement was an outstanding lawyer. He proved it. The New York Times’coverage of one exchange illustrates why.

Reporter Adam Liptak, after claiming that Justice Anthony Kennedy’s “touchstone and guiding principle” is liberty, went on to write this:

The point was not lost on Solicitor General Donald B. Verrilli Jr., who concluded his defense of the law at the court this week with remarks aimed squarely at Justice Kennedy. Mr. Verrilli said there was “a profound connection” between health care and liberty.

“There will be millions of people with chronic conditions like diabetes and heart disease,” he said, “and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.”

Paul D. Clement, representing 26 states challenging the law, had a comeback. “I would respectfully suggest,” he said, “that it’s a very funny conception of liberty that forces somebody to purchase an insurance policy whether they want it or not.”

Before the Supreme Court’s oral argument on the Patient Protection and Affordable Care Act, I was told by people I trust that Paul Clement was an outstanding lawyer. He proved it. The New York Times’coverage of one exchange illustrates why.

Reporter Adam Liptak, after claiming that Justice Anthony Kennedy’s “touchstone and guiding principle” is liberty, went on to write this:

The point was not lost on Solicitor General Donald B. Verrilli Jr., who concluded his defense of the law at the court this week with remarks aimed squarely at Justice Kennedy. Mr. Verrilli said there was “a profound connection” between health care and liberty.

“There will be millions of people with chronic conditions like diabetes and heart disease,” he said, “and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.”

Paul D. Clement, representing 26 states challenging the law, had a comeback. “I would respectfully suggest,” he said, “that it’s a very funny conception of liberty that forces somebody to purchase an insurance policy whether they want it or not.”

Clement is quite correct; it is a very funny conception of liberty. A distorted one, in fact. And it perfectly represents the intellectual state of modern liberalism, where coercion is synonymous with liberty.

Do voters exist? In the United States, that is–do we still have voters? All available evidence points to yes, we have millions upon millions of them who vote in national elections. But maybe I’m getting too caught up in the numbers. Recent anecdotal evidence challenges my theory. I’m referring, of course, to the obvious consequences if the Supreme Court strikes down Obamacare. The result, everyonesays, will be single-payer, government-run health care for all.

The problem, though, is that this was suggested and polled repeatedly during the health care debates in 2009-10. As the debates dragged on, a single-payer health care program repeatedly polled as the least popular path to universal coverage, and its poll numbers dropped over time. So I’ll pose a simple question: If the entire Obamacare law is struck down, will President Obama campaign on a single-payer system? No, he won’t. And the reason is because it will hurt him with voters, who in the end really do exist. Ezra Klein has, however, proposed a feasible way for the Democrats to move toward a default single-payer system:

I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children’s Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans — and particularly a majority of Americans who have significant health risks — are covered by the government.

Do voters exist? In the United States, that is–do we still have voters? All available evidence points to yes, we have millions upon millions of them who vote in national elections. But maybe I’m getting too caught up in the numbers. Recent anecdotal evidence challenges my theory. I’m referring, of course, to the obvious consequences if the Supreme Court strikes down Obamacare. The result, everyonesays, will be single-payer, government-run health care for all.

The problem, though, is that this was suggested and polled repeatedly during the health care debates in 2009-10. As the debates dragged on, a single-payer health care program repeatedly polled as the least popular path to universal coverage, and its poll numbers dropped over time. So I’ll pose a simple question: If the entire Obamacare law is struck down, will President Obama campaign on a single-payer system? No, he won’t. And the reason is because it will hurt him with voters, who in the end really do exist. Ezra Klein has, however, proposed a feasible way for the Democrats to move toward a default single-payer system:

I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children’s Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans — and particularly a majority of Americans who have significant health risks — are covered by the government.

It certainly could happen. Klein isn’t in love with the idea, to say the least. But yes, it’s a possibility. But the part I take issue with is the first sentence, in which Klein says everybody walks away from the health insurance issue for a decade. I don’t think Obama would do that, and I don’t think the election could pass by without health care thrust right back in the debate, only this time centered on the question of how to replace Obamacare.

So in that case, politically, what does Obama do? Like I said, I don’t think he runs as an advocate for single-payer. Klein’s suggestion is probably workable in the long run, but Obama can’t run on it. He cannot stage a re-election campaign on the idea that he’ll give up the reform game and that it’s now up to Harry Reid to slowly and quietly bring us to the cusp of single-payer while everyone else is distracted watching “Mad Men” and arguing over Tim Tebow.

Again, I don’t doubt the feasibility of this incremental Medicare-for-all approach. But elections include voters, and voters will want to know what the candidates are going to do about health care if Obamacare disappears entirely. The president cannot say “nothing.” He cannot say “trust us, we’ll take care of it in a way that requires no public discussion and no voter input.” And he cannot say: “We’ll do what Canada and Britain have done.” So what will he say?

During the past year, opinion polls have consistently shown widespread public disapproval of President Obama’s health care reform law. The Hill has a new survey out reaffirming this, as the Supreme Court prepares to hear arguments on the constitutionality of the law later today.

The most interesting takeaway from the poll is that the disapproval for ObamaCare is spread across most voting demographics, including two key groups that Democrats have argued benefit most from the law: young people and women. From The Hill:

By a 52-percent-to-39-percent margin women are more opposed to it than men, who oppose it 48 percent to 45 percent, a difference that matches the poll’s 3-point margin of error. …

While even the youngest voters oppose the law (47 percent to 42 percent among those aged 18-39), opposition grows to 53 percent among voters aged 65 and older.

During the past year, opinion polls have consistently shown widespread public disapproval of President Obama’s health care reform law. The Hill has a new survey out reaffirming this, as the Supreme Court prepares to hear arguments on the constitutionality of the law later today.

The most interesting takeaway from the poll is that the disapproval for ObamaCare is spread across most voting demographics, including two key groups that Democrats have argued benefit most from the law: young people and women. From The Hill:

By a 52-percent-to-39-percent margin women are more opposed to it than men, who oppose it 48 percent to 45 percent, a difference that matches the poll’s 3-point margin of error. …

While even the youngest voters oppose the law (47 percent to 42 percent among those aged 18-39), opposition grows to 53 percent among voters aged 65 and older.

While President Obama didn’t personally commemorate the two-year anniversary of his health care law last week, his campaign has been emphasizing the supposedly positive impact the law will have on women and young Americans. Obviously, the numbers in The Hill poll complicate that message. The fact that women are more likely to oppose the law than men is particularly interesting, and gives the GOP an opening to try to frame this as a women’s issue.

But the poll also bolsters one of the main arguments we may hear from Democrats if the Supreme Court does end up overturning the law or portions of it. While voters want to see the law repealed, they also believe the justices’ eventual decisions may be politically motivated:

Although voters want the Court to strike the law, they don’t necessarily trust the justices’ motivations. Fifty-six percent of likely voters believe the justices are swayed by their own political beliefs, while just 27 percent believe they “make impartial decisions based on their reading of the Constitution.”

When people decry “judicial activism,” often they’re really using it as a euphemism for a decision they don’t like or don’t agree with. If the law is struck down, the health care issue will likely become an election-year motivator for Democratic voters, and the blame will no doubt be pinned on conservative activist judges.

ObamaCare’s gross cost during the next ten years is expected to nearly double the $940 billion price tag projected in 2009. Phil Klein reports on the Democratic Party’s sketchy math that resulted in the discrepancy:

Democrats employed many accounting tricks when they were pushing through the national health care legislation, the most egregious of which was to delay full implementation of the law until 2014, so it would appear cheaper under the CBO’s standard ten-year budget window and, at least on paper, meet Obama’s pledge that the legislation would cost “around $900 billion over 10 years.” When the final CBO score came out before passage, critics noted that the true 10-year cost would be far higher than advertised once projections accounted for full implementation.

Today, the CBO released new projections from 2013 extending through 2022, and the results are as critics expected: the ten-year cost of the law’s core provisions to expand health insurance coverage has now ballooned to $1.76 trillion.

ObamaCare’s gross cost during the next ten years is expected to nearly double the $940 billion price tag projected in 2009. Phil Klein reports on the Democratic Party’s sketchy math that resulted in the discrepancy:

Democrats employed many accounting tricks when they were pushing through the national health care legislation, the most egregious of which was to delay full implementation of the law until 2014, so it would appear cheaper under the CBO’s standard ten-year budget window and, at least on paper, meet Obama’s pledge that the legislation would cost “around $900 billion over 10 years.” When the final CBO score came out before passage, critics noted that the true 10-year cost would be far higher than advertised once projections accounted for full implementation.

Today, the CBO released new projections from 2013 extending through 2022, and the results are as critics expected: the ten-year cost of the law’s core provisions to expand health insurance coverage has now ballooned to $1.76 trillion.

However, the projected net cost of ObamaCare is actually down, though not for a particularly encouraging reason. The CBO estimates that many more Americans will lose private insurance coverage under ObamaCare than previously thought, which means the federal government will rake in more revenue from fining uninsured individuals and businesses that don’t provide coverage. IBD reports:

The projected rise in revenue is ironically largely due to the increase in the uninsured and the decline in employer-based coverage.

The government will fine individuals $45 billion — up from $34 billion — for failing to have insurance. Businesses are expected to pay $96 billion for not providing coverage, an increase of $15 billion.

Another $81 billion in higher net revenues comes largely from employees no longer getting tax-exempt health insurance but instead being paid more in taxable wages.

So ObamaCare will cost more than thought, but make up for it by increasing the number of Americans who are uninsured, and thus fineable. And remember, this is all happening because the Obama administration wanted to lower insurance costs and provide more coverage for the uninsured.

Could the Obama administration make it any clearer that it has little regard or respect for the men and women who make the world safe so that the president can indulge so happily in the rich man’s game, and his wife and family can gallivant so luxuriously around the globe?

Bill Gertz at the Washington Free Beaconreported yesterday on some strong opposition from the VFW, the Military Officers Association of America, and House Armed Services Committee Chairman Howard “Buck” McKeon to the Pentagon’s plan to lay some of its budget cutting squarely on the backs of military personnel by raising their healthcare fees.

Could the Obama administration make it any clearer that it has little regard or respect for the men and women who make the world safe so that the president can indulge so happily in the rich man’s game, and his wife and family can gallivant so luxuriously around the globe?

Bill Gertz at the Washington Free Beaconreported yesterday on some strong opposition from the VFW, the Military Officers Association of America, and House Armed Services Committee Chairman Howard “Buck” McKeon to the Pentagon’s plan to lay some of its budget cutting squarely on the backs of military personnel by raising their healthcare fees.

Specifically, if President Obama and Defense Secretary Panetta have their way, active duty servicemen and women will have to pay higher co-payments for prescriptions and will no longer get incentives for buying generic drugs. And military retirees will see 30 percent to 78 percent increases in their annual healthcare premiums for the first year, and after that, five-year increases from 94 percent to 345 percent.

Meanwhile, guess who gets off scot-free in the budget-cutting scheme? Surprise! It’s civilian workers – in the Department of Defense and other agencies – who happen to belong to that last bastion of labor movement power, government employee unions. And just to hedge the president’s bets on another four cushy years in the White House, the increases aren’t scheduled to begin until after the election.

Oh, and, for anyone who still buys Obama’s promise that we’ll be able to keep our current plans if we like them, apparently his administration expects that one of the side benefits of the planned increases will be to push American soldiers, sailors and flyboys (and girls) away from their military healthcare plans and into the waiting arms of the Patient Protection and Affordable Care Act program.

Hot air about supporting our troops from Mrs. Obama and Dr. (Jill) Biden notwithstanding, it’s pretty obvious where the sympathies of this White House lie.

The debate about Obamacare and the way the government is using it to mandate that institutions pay for services they oppose such as contraception has brought the whole question of intrusive federal regulation back into the public eye. But those who believe this is something that will be limited to health care are probably deceiving themselves. The impulse to tell people how they should live and what they should do is implicit in the ideology that gave birth to Obamacare. If some influential people have their way, Washington’s power to impose its will may be extended into other spheres that were heretofore considered so far out of the government’s purview as to have been considered laughable. But as New York Times Magazine food columnist Mark Bittman wrote yesterday, the day may be fast approaching when government bureaucrats will be telling some, if not all citizens, what foods they may or may not eat.

Bittman picks up on the attempt by a conservative Republican in the Florida legislature to pass a bill that would prevent recipients of food stamps from spending their chits on junk food like candy, chips or soda. The willingness of a right-winger to join the food police encourages Bittman to think the time will not be long before sugar is regulated the way the production and marketing of alcohol and tobacco are controlled by the government. While Bittman’s nutritional advice about the dangers of over-consumption of products drenched in sugar and corn syrup is well taken, the notion that such choices will be taken out of the hands of consumers ought to frighten anyone who values individual freedom and understands the perils of a nanny state. Some may scoff at this possibility, but the Obamacare precedent and the power the president’s signature program will give the government may change everything in the future. Bittman’s argument that the costs of health care will make such government micro-managing of our lives inevitable may prove prophetic if Obamacare is not repealed next year.

The debate about Obamacare and the way the government is using it to mandate that institutions pay for services they oppose such as contraception has brought the whole question of intrusive federal regulation back into the public eye. But those who believe this is something that will be limited to health care are probably deceiving themselves. The impulse to tell people how they should live and what they should do is implicit in the ideology that gave birth to Obamacare. If some influential people have their way, Washington’s power to impose its will may be extended into other spheres that were heretofore considered so far out of the government’s purview as to have been considered laughable. But as New York Times Magazine food columnist Mark Bittman wrote yesterday, the day may be fast approaching when government bureaucrats will be telling some, if not all citizens, what foods they may or may not eat.

Bittman picks up on the attempt by a conservative Republican in the Florida legislature to pass a bill that would prevent recipients of food stamps from spending their chits on junk food like candy, chips or soda. The willingness of a right-winger to join the food police encourages Bittman to think the time will not be long before sugar is regulated the way the production and marketing of alcohol and tobacco are controlled by the government. While Bittman’s nutritional advice about the dangers of over-consumption of products drenched in sugar and corn syrup is well taken, the notion that such choices will be taken out of the hands of consumers ought to frighten anyone who values individual freedom and understands the perils of a nanny state. Some may scoff at this possibility, but the Obamacare precedent and the power the president’s signature program will give the government may change everything in the future. Bittman’s argument that the costs of health care will make such government micro-managing of our lives inevitable may prove prophetic if Obamacare is not repealed next year.

Bittman is right to say obesity has become a major national health problem. Nor would I dispute his arguments that American nutritional habits are doing us and the country no good. But the notion that this is reason enough to give the government the power to prevent people from buying the food they wish to eat is a fundamental assault on individual liberty.

Food stamp recipients are vulnerable to such regulation because their poverty and dependence renders them helpless against such intrusions. If they are taking our money, some people reason, then we should be able to tell them what to do, especially if it is obviously for their own good. But this sort of utilitarian argument has no limits. If the national exchequer is burdened by the costs of caring for those who suffer from obesity, then we can just as easily be told that sugar or any other substance selected by the food police (Bittman prefers the term “vigilantes”) can be regulated or banned for everyone, not just those who rely on government handouts.

The ideological underpinning of this thinking can be found in Bittman’s assertion that it is the government’s job to take care of itself. If, as he believes, the government is failing to sufficiently protect us from ourselves, then it is time for enlightened souls to step in and force it to take control. However well-intentioned Bittman’s prescription for the national diet may be, government involvement on the scale that he is discussing is the epitome of the political trend that Jonah Goldberg aptly styled Liberal Fascism.

One might assume the food industry will fight this expansion of government control tooth and nail. But the example of Obamacare demonstrates all too well how businesses can be co-opted into acquiescing to a takeover by the federal leviathan. Unless Obamacare is stopped next year by a new president and Congress, we may well eventually find out just how far the reach of an empowered government can go.